Strong evidence has been found to link the diagnosis of CHD with depression, and patients with all CHD-related diagnoses and co-morbid depression display higher morbidity and mortality from CHD than those individuals without depression. Screening and treatment of depression by cardiology clinicians continues to be limited due to poor symptom recognition and lack of desire to treat perceived primary care conditions in specialty practice. The American Heart Association has designated timely assessment and treatment/referral of depression as primary goals for high-quality evidenced-based cardiology care to improve patient outcomes in CHD.This study employed a quasi-experimental descriptive pretest-posttest study design for the purposes of (1) understanding diagnostic and treatment practices for depression in the presence of CHD by nurse practitioner and physician cardiology providers (n=35) in a large metropolitan private outpatient cardiology practice and; (2) adaptation of a valid and reliable depression screening tool (Patient Health Questionnaire-9) to an existing electronic medical record system for use in the sample practice.Findings from the study showed that even though all providers (100%) believed that depression inhibited patients' ability to make positive CHD risk-reducing lifestyle changes, and the majority (73.7%) felt that depression contributed to the progression of CHD, no formal screening for depression was being performed. Less than half (42.1%) of providers in the sample treated depression in their clinic practice, and the large majority (89.5%) referred patients back to primary providers for all depression care.Since 2008 guidelines for depression care by cardiology providers were recommended by the American Heart Association (endorsed by the American Psychiatric Association), it is questionable if these recommendations are filtering down to outpatient cardiology practice. Provider education to improve confidence with depression screening and treatment, and provision of concise easy-to-use care templates in outpatient EMR systems may help to improve compliance with recommendations while maximizing patient outcomes for depressed CHD patients.Advanced practice nurses have been consistently instrumental in the development and management of performance-enhancing processes that improve care quality and patient outcomes. As nursing practice leaders, nurse practitioners should be progressive in supporting implementation of best-practice for depression care in outpatient cardiology practice settings.

No / The aim of this prospective randomized study was to evaluate the role of carbon dioxide (CO2) and normal saline for diagnostic accuracy in out-patient hysteroscopy. Women admitted to our Department in order to undergo total abdominal hysterectomy also underwent diagnostic hysteroscopy, 12¿24 h prior to surgery. The selection of distending medium was made after randomization. Two groups of patients were formed, group A (CO2; n=39) and group B (normal saline; n=35). More than half of the women in the study population were post-menopausal. Post-hysteroscopy, all women were asked to rank any symptom that they felt during the procedure on a 4-point scale (0 = none; 1 = mild; 2 = severe; 3 = inability to perform hysteroscopy). The hysteroscopic diagnosis was compared with the macroscopic findings and the histological examination of the surgical specimen after hysterectomy. The percentage who completed hysteroscopy was 89.74% within group A and 97.14% within group B. Most patients of both groups felt some pain of mild intensity. The diagnostic accuracy of hysteroscopy was similar for both media when major pathology [large polyps (group A 91.7%; group B 92.7%), myomas (group A 81.25%; group B 92.7%) and/or hyperplasia (group A 87.5%; group B 90.2%)] of the endometrial cavity was detected. In contrast, in cases of minor pathology (small polyps, mucosal elevations, crypts, hypervascularization), hysteroscopy with saline presented with significantly higher diagnostic accuracy (85.4%) compared with hysteroscopy with CO2 (64.6%). In out-patient hysteroscopy, CO2 and normal saline were comparable with regard to patient discomfort and for the detection of major pathology of the endometrial cavity. Normal saline seems to be the most appropriate medium for the detection of minor pathology of the endometrial cavity.

In my thesis I deal with the postpenitenciary care in ambulatory services for drug users. The aim of this study was to explore why clients seek and visit the institute, where my study took place, what services they used and which services did they miss there. Then I investigated reasons of their early abortion of these services. For these purposes, I chose a qualitative study - six case studies of clients who have used postpenitenciary services. My research took place in one organization - the ambulatory center for drug users. I was in contact with the clients throughout their whole attendance at the service. For the purpose of qualitative research I used data folders of the clients - records of consultations made with clients and all documents that were relevant for the study. All respondents were sent to the institution by workers of Probation and Mediation Service for Czech Republic. Four of the six clients completed the program properly. Two clients aborted the service earlier. Due to the quantity of the research sample we can not generalize these information, but we can say, that the provision of postpenitenciary care is very important to map the client's situation, individual access to his or her needs, and on this basis to select the appropriate interventions in work with theem, which I...

Earlier studies show that when psychiatric out- and in-patient care units work together the risk for hospitalization decreases, leads to increased flexibility and shorter in-patient periods. At a psychiatric clinic in western Sweden there are routines in place regarding the transfer of patients from in-patient to out-patient care. The aim of this study was to describe nurses' experience of how out-and in-patient clinics collaborate during patients in-patient care. This is a qualitative study with an inductive approach. Ten nurses participated through semi structured interviews. The result ended up in two domains and eight subthemes and one theme, the diffuse responsibility – makes us not understand each other. Nurses in both out- and in-patient care experience uncertainty as to who has the responsibility for patients' treatment-plans and also uncertainty in how communication between the two parties works. Nurses in in-patient care experience that the out-patient care are uninterested, and nurses in out-patient care experience that in-patient care does not follow treatment-plans. In Conclusion both nurses in out- and in-patient care describe a need for an improved partnership. Some find that they are unsure of their role and their responsibility in the partnership. Structures for an improved partnership need to be implemented from the staff leadership, to be able to live up to the national guidelines and ensure that patients receive the treatment which serious psychiatric illness needs.

Magister Curationis - MCur / This mini-thesis is an investigation of the barriers (if any) to utilisation of child and adolescent out-patient mental health services in the Division of Child and Adolescent Psychiatry at a children’s hospital in Cape Town, South Africa. It explores the reasons that make the patients not to honour their appointments. The study examines the relationship between the dependent variables (attendance (0), and non-attendance (1)), and independent variables which are demographic factors (age, sex, education, race, employment, marital status, area of residence, form of treatment, diagnosis and frequency of missed appointments) and continuous variables (finance/costs, language, knowledge, stigma, support system, culture/religion, confidentiality, work, school, service, and other miscellaneous variables (forgetting, inconvenience, refusing, frequency of appointments, and length of the session and emergency). The literature reviewed in the study revealed that non-attendance in mental health is a universal phenomenon, which affects everyone regardless of race, ethnicity or economic class. Furthermore, child mental health differs from other health fields in that almost all the patients are brought for consultation, somehow, against their will (Eapen & Jairam, 2009). In the study, the present researcher argues that even though non-attendance in child and adolescent psychiatry is a universal phenomenon, and literature is consistent in the findings on the barriers to utilisation of mental health services in other parts of the world, there is poor information on similar studies on South Africa, and particularly in Cape Town, where this study is based. This study will therefore contribute information to the existing body of knowledge in this area of child and adolescent mental health care services. iv The present researcher used a quantitative approach and Non-experimental design. Notably, the researcher used random stratified sampling with a population of patients who consulted with the Division of Child and Adolescent Out-patient Psychiatry Unit and at Neuropsychiatry Outpatient Clinic from the 1st of January 2011 to the 31st of December 2011, who missed appointments, and those who never missed appointments. The researcher conducted a survey using self-administered structured questionnaires, with children from 9 years to 18 years, and all parents/caregivers. The data is analysed using the Statistical Package for the Social Sciences (SPSS) software, Version 19.0 and Descriptive and inferential statistics. Findings from this study showed that all other independent variables investigated are statistically insignificant and are not associated with non-attendance in this out-patient unit, except for school related reasons which are found to be dominant possible barriers for attendance, and culture/religion is also statistically significant and has a weak association with non-attendance. These findings have implications on service delivery in this unit. Based on the findings, this mini-thesis concludes with a recommendation that services may possibly need to be reviewed to meet the needs of the patients in order to improve utilisation. I also recommend that this study be rolled out to other community clinics in the Western Cape, as it was done on a smaller scale, and only in one out-patient unit.

<h1>Sammanfattning</h1><p>Syftet med denna kvalitativa studie är att undersöka klienters erfarenheter av två former av missbruksvård. De undersökta verksamheterna är Alkohol- och narkotikagruppen, vilket är en öppenvårdsverksamhet i Lindesberg, samt Stiftelsen Bergslagsgårdar i Örebro, som bland annat arbetar med familjehemsvård för vuxna.</p><p>Intervjuer har utförts med åtta klienter mellan 25 till 58 år, varav fyra berördes från varje verksamhet. Den kontextuella missbruksbakgrunden var varierad.</p><p>Den semistrukturerade intervjuguiden har utformats utifrån studiens syfte, frågeställningar och tolkningsram. De teoretiska utgångspunkter som tillämpats är identitet, social värld samt copingstrategier. Tidigare forskning har studerats inom missbruksvård, motivation, tvång och frivillighet samt vilka nyckelingredienserna är för en lyckad missbruksvård.</p><p> </p><p>Resultat och analys har uppdelats i tre teman:</p><p> </p><p>1)      Synpunkter på vården,</p><p>2)      Upprätthållande av missbruksfrihet</p><p>3)      Social tillhörighet och förändring.</p><p> </p><p>Resultatet indikerar en genomgående positiv inställning hos klienterna till vårdformerna och att motivationen är viktig för resultatet av vården. Motivationen har uppkommit antingen före vården inletts eller under vårdtiden, antingen som en följd av sociala förhållanden eller genom relationen till behandlaren. Slutligen antyder resultatet att kombinationen av vård tillsammans med någon annan social omständighet samverkat till upprätthållandet av missbruksfrihet.</p> / <h1>Abstract</h1><p>The aim of this qualitative study is to examine client experience of two kinds of addiction treatment. The examined organisations were The Alcohol and Narcotic Group, which is an out-patient program in Lindesberg, and The Foundation of Bergslagsgårdar in Örebro, which specialises in family home treatment for adults.</p><p>Interviews were conducted with eight clients between 25 to 58 years of ages, with four clients taken from each organisation. Each client had a contextual substance abuse variation. A semi-structured interview guide was formulated according to the aim of the study and the research questions, within an interpretive framework. The implemented theoretical contexts used are identity, social world and coping strategies. This study builds upon previous research pertaining to addiction treatments, motivation, forced or voluntarily care, and effective key ingredients within addiction treatments.</p><p> </p><p>The result and analysis have been divided into three themes:</p><p>1)      Opinions about treatment</p><p>2)      Maintaining freedom from substance abuse</p><p>3)      Social inclusion and change</p><p>The result indicates that client attitude is consistently positive towards treatment and that motivation is important for rehabilitation. Client motivation arises either before the treatment's start or during its duration, as a consequence of social conditions and/or through interaction with care givers. The result emphasises that a combination of care treatments coupled with other social conditions have produced clients with the ability to maintain freedom from substance abuse.</p>

Sammanfattning Syftet med denna kvalitativa studie är att undersöka klienters erfarenheter av två former av missbruksvård. De undersökta verksamheterna är Alkohol- och narkotikagruppen, vilket är en öppenvårdsverksamhet i Lindesberg, samt Stiftelsen Bergslagsgårdar i Örebro, som bland annat arbetar med familjehemsvård för vuxna. Intervjuer har utförts med åtta klienter mellan 25 till 58 år, varav fyra berördes från varje verksamhet. Den kontextuella missbruksbakgrunden var varierad. Den semistrukturerade intervjuguiden har utformats utifrån studiens syfte, frågeställningar och tolkningsram. De teoretiska utgångspunkter som tillämpats är identitet, social värld samt copingstrategier. Tidigare forskning har studerats inom missbruksvård, motivation, tvång och frivillighet samt vilka nyckelingredienserna är för en lyckad missbruksvård.   Resultat och analys har uppdelats i tre teman:   1)      Synpunkter på vården, 2)      Upprätthållande av missbruksfrihet 3)      Social tillhörighet och förändring.   Resultatet indikerar en genomgående positiv inställning hos klienterna till vårdformerna och att motivationen är viktig för resultatet av vården. Motivationen har uppkommit antingen före vården inletts eller under vårdtiden, antingen som en följd av sociala förhållanden eller genom relationen till behandlaren. Slutligen antyder resultatet att kombinationen av vård tillsammans med någon annan social omständighet samverkat till upprätthållandet av missbruksfrihet. / Abstract The aim of this qualitative study is to examine client experience of two kinds of addiction treatment. The examined organisations were The Alcohol and Narcotic Group, which is an out-patient program in Lindesberg, and The Foundation of Bergslagsgårdar in Örebro, which specialises in family home treatment for adults. Interviews were conducted with eight clients between 25 to 58 years of ages, with four clients taken from each organisation. Each client had a contextual substance abuse variation. A semi-structured interview guide was formulated according to the aim of the study and the research questions, within an interpretive framework. The implemented theoretical contexts used are identity, social world and coping strategies. This study builds upon previous research pertaining to addiction treatments, motivation, forced or voluntarily care, and effective key ingredients within addiction treatments.   The result and analysis have been divided into three themes: 1)      Opinions about treatment 2)      Maintaining freedom from substance abuse 3)      Social inclusion and change The result indicates that client attitude is consistently positive towards treatment and that motivation is important for rehabilitation. Client motivation arises either before the treatment's start or during its duration, as a consequence of social conditions and/or through interaction with care givers. The result emphasises that a combination of care treatments coupled with other social conditions have produced clients with the ability to maintain freedom from substance abuse.

Relatively few pre-treatment interventions to increase out-patient mental health (MH) service use have been created and experimentally tested. Therefore, not only is there limited availability of these interventions, it is uncertain whether existing interventions are effective. Moreover, it is unclear which components of the interventions are effective. To address these gaps in knowledge, a systematic review of pre-treatment interventions was conducted, using the Cochrane Review methodology. Three primary outcomes were evaluated: attendance at any type of out-patient MH visit; number of appointments of any type of out-patient MH visit; and/or initiation and adherence to psychotropic medication. PubMed and PsycINFO databases were thoroughly searched for studies that met the inclusion criteria. A data extraction form was designed and employed to systematically extract data from all included studies. In the 15 included studies, 18 different active interventions were evaluated. The interventions ranged in duration of interaction from one mailed flyer to ten 90-minute psychoeducation sessions. Most studies (n = 11) included one intervention group, compared with one control, or usual care, group. The interventions were categorized by the type of barriers they aimed to address, resulting in six broad categories: MH knowledge; MH knowledge/attitudes; MH knowledge/attitudes/ logistical barriers; MH knowledge/family involvement; care management; and home visits. All included studies received a quality assessment rating of "good" or "fair." The main finding of this thesis is that all categories of interventions increased at least two of the three primary outcomes. The care management interventions measured and increased all three outcomes; these interventions also had some of the highest quality ratings. Therefore, care management interventions appear most effective at increasing out-patient MH service use. Implications for practice and research are discussed.

Eating disorders (ED) usually develop during adolescence, and intervention to stop further weight loss is believed to improve outcome and long-term prognosis. Adolescents with ED who do not receive effective treatment risk poor outcome and even untimely death as adults. The first aim of this thesis was to investigate long-term mortality and causes of death in a series of female adults with chronic ED. The second aim was to study the one-year outcome of an unselected series of adolescent girls with anorexia nervosa (AN) and “other restrictive eating disorders” who had been treated within a specialist ED out-patient service focused on nutritional rehabilitation based on family therapy and without planned hospitalization. The third aim was to investigate the possible metabolic and hormonal side effects of olanzapine when used as an adjunct to facilitate nutritional rehabilitation. The fourth aim was to investigate the relationship between polyunsaturated fatty acid (PUFA) status and depression. In adult women with chronic ED, a very low body mass index and psychiatric co-morbidity confer a substantially increased risk of premature death. A treatment programme for adolescent ED with rapid access to assessment and prompt start of treatment with initial emphasis on nutritional rehabilitation proved efficient. The outcome was encouraging, as 43% of all patients with ED and 19% of those with AN did not have an ED at one-year follow-up. Of the remaining patients the vast majority had gained weight and regained menstruation, and were back in school on a full-time basis. Olanzapine was used to reduce anxiety, excessive exercise and rumination over weight and shape. Side effects were similar to those observed in normal-weight individuals, and do not preclude its use in underweight adolescents with ED. Low ω3 PUFA were associated with depression. The ω3 PUFA status improved during nutritional rehabilitation with ordinary foods and without supplementation. The investigations indicate that adolescent ED can be successfully treated in an out-/day-patient setting. An essential feature of the service is rapid handling and weight gain. Further weight loss can be avoided, and chronic disease hopefully prevented.

Ziel dieser Studie ist, einen aktuellen Statusbericht zu Standortdichte, räumlicher Bedarfsabdeckung und demografischen Rahmenbedingungen für die ambulante und stationäre hos-pizliche und palliative Versorgung in Sachsen zu erstellen. Dabei sollen aktuelle Versorgungslücken identifiziert und der künftige Bedarf (2020–2030–2050) an Angeboten auf Ebene der Landkreise und Kreisfreien Städte herausgearbeitet werden. Für die Ableitung der Normwerte zeigt sich, dass angesichts der hohen Sterblichkeitsunterschiede zwischen den Bundesländern eine Bedarfsermittlung auf der Basis bundesdurchschnittlicher Normwerte je Bevölkerung nicht zufriedenstellend ist. Deshalb empfiehlt die Studie, in der regionalen Planung der Hospiz- und Palliativversorgung auf die erwarteten Sterbefälle abzustellen, die sich unter Berücksichtigung der Altersstruktur ergeben. Dieses bedeutet, dass die Normwerte der DGP zur Berechnung der Sollwerte um Bevölkerungsstruktur und Sterblichkeit korrigiert werden. In einer abschließenden Bewertung werden – vor dem Hintergrund einer Stärken- und Schwächenanalyse aus Experteninterviews – weitere Handlungsempfehlungen abgeleitet, die auch die Dimensionen von Qualität der Leistungserbringung, Ausbildung, Finanzierung und deren Anreizwirkung sowie Integration einbeziehen.